NEED ADVICE ON TENOFOVIR AND HIGH ALT

[Solly21]

Started TENOFOVIR July 2018 when Hbv DNA was 42000IU/ML ,
HBsag quantitative ,27136.78 IU/ML
HBeag negative. ALT was 28U/L
Results @ August 2019.
Hbv DNA .. undetected
ALT 46.9 U/L , range 10 - 40
AST 41 U/L , range 10- 42
Direct bilirubin, 2.6 umol/L range 0-8
Total bilirubin. 14.4. range 2-20
GFR 69 ml/mom/1.73m^2
Results at September 2020
Hbvdna undetected
Hbsag quantitative 13312.63 IU/ML
GFR 92

Results at April 2021
Hbv DNA .. undetected
ALT 44U/L , range 10 - 40
AST 41 U/L , range 10- 42
Direct bilirubin, 6.8 umol/L range 0-8
Total bilirubin. 22 range 2-20
GFR 77 ml/mom/1.73m^2
my concern is high ALT and bilirubin level,
Is this high level normal while on TENOFOVIR drug?
What can I do to make it be in normal range?
I noticed the HBsag has reduced from 27k to 13k
Please I need urgent advice.

[Quincyw33]

I do not have any experience with tenofovir since I have never been on it.  But I want to give you my advice since I would also want advice if I were you. Even though your ALT is a little high it is not extremely high. However, I understand why you are concerned and you should try to get it back into normal ranges.

I would advise you to do a vitamin D test. I would not be surprised if your vitamin D levels are low. If your vitamin D levels are a little low, I would recommend taking a vitamin D supplement. It will help your ALT levels to normalize. Try to get your Vitamin D level over 30.

[melcul]

ALT is like heart rate, the lower the better.  Your ALT might be high for different reasons. like fatty liver, for example. not necessarily related to HBV. I wouldn't worry too much, the result it's not ideal,  but it's ok. Keep diet if you don't already. I can see your kidney function improve, which is great. I don't know about the bilirubin.

[Solly21]

Thanks for your advice, I have added 8kg within one year to do changes in life style. I will consider diet to reduce weight,
Should I switch medicine from TENOFOVIR  to TAF ? . I hope no serious damage to the liver with the current ALT level

[melcul]

I would personally change it only If I'd have any issues with the current medication and the doctor would recommend it. Your kidney results are confusing to me though, in 2018 you have both: GFR 69 ml/mom/1.73m^2, and  GFR 92,   followed by this year's GFR 77 ml/mom/1.73m^2.  Keep in mind to stay properly hydrated all the time.

[Solly21]

I did fibroscan test today,
Results is ;
Median stiffness 4.8kpa
IQR. 0.9kpa
IQR/med. 19%
Valid results 20
Success rate 100%
Liver 4.8kpa = F0/F1

Ultrasound normal liver.
My doctor change my drug to TAF . She said there is great improvement from 8.9kpa reading of fibroscan I have 5 yrs ago before I start treatment.